University of Kentucky UKnowledge Theses and Dissertations--Rehabilitation Sciences Rehabilitation Sciences 2017 THE RELATIONSHIP BETWEEN SELECTIVE ATTENTION AND GLOBAL COHERENCE IN NARRATIVE DISCOURSE FOLLOWING RIGHT HEMISPHERE STROKE Katherine McComas Maddy University of Kentucky, [email protected] Digital Object Identifier: https://doi.org/10.13023/ETD.2017.440 Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Maddy, Katherine McComas, "THE RELATIONSHIP BETWEEN SELECTIVE ATTENTION AND GLOBAL COHERENCE IN NARRATIVE DISCOURSE FOLLOWING RIGHT HEMISPHERE STROKE" (2017). Theses and Dissertations--Rehabilitation Sciences. 43. https://uknowledge.uky.edu/rehabsci_etds/43 This Doctoral Dissertation is brought to you for free and open access by the Rehabilitation Sciences at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--Rehabilitation Sciences by an authorized administrator of UKnowledge. For more information, please contact [email protected]. STUDENT AGREEMENT: I represent that my thesis or dissertation and abstract are my original work. Proper attribution has been given to all outside sources. I understand that I am solely responsible for obtaining any needed copyright permissions. I have obtained needed written permission statement(s) from the owner(s) of each third-party copyrighted matter to be included in my work, allowing electronic distribution (if such use is not permitted by the fair use doctrine) which will be submitted to UKnowledge as Additional File. I hereby grant to The University of Kentucky and its agents the irrevocable, non-exclusive, and royalty-free license to archive and make accessible my work in whole or in part in all forms of media, now or hereafter known. I agree that the document mentioned above may be made available immediately for worldwide access unless an embargo applies. I retain all other ownership rights to the copyright of my work. I also retain the right to use in future works (such as articles or books) all or part of my work. I understand that I am free to register the copyright to my work. REVIEW, APPROVAL AND ACCEPTANCE The document mentioned above has been reviewed and accepted by the student’s advisor, on behalf of the advisory committee, and by the Director of Graduate Studies (DGS), on behalf of the program; we verify that this is the final, approved version of the student’s thesis including all changes required by the advisory committee. The undersigned agree to abide by the statements above. Katherine McComas Maddy, Student Dr. Gilson J. Capilouto, Major Professor Dr. Esther Dupont-Versteegden, Director of Graduate Studies THE RELATIONSHIP BETWEEN SELECTIVE ATTENTION AND GLOBAL COHERENCE IN NARRATIVE DISCOURSE FOLLOWING RIGHT HEMISPHERE STROKE DISSERTATION A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the College of Health Sciences at the University of Kentucky By Katherine McComas Maddy Lexington, Kentucky Co-Directors: Dr. Gilson Capilouto, Professor of Communication Sciences and Disorders and Dr. Anne Harrison, Professor of Physical Therapy Lexington, Kentucky Copyright Ó Katherine McComas Maddy 2017 1 ABSTRACT OF DISSERTATION THE RELATIONSHIP BETWEEN SELECTIVE ATTENTION AND GLOBAL COHERENCE IN NARRATIVE DISCOURSE FOLLOWING RIGHT HEMISPHERE STROKE Stroke is the leading cause of serious, long-term disability and nearly half of older stroke survivors experience moderate to severe disability. A common impairment following stroke is impaired discourse production. Functional outcome studies have proposed that the recovery of discourse abilities is critical to achieving a good quality of life. Communication impairments often persist into the chronic stages of recovery and can cause individuals to withdraw from social situations. Discourse production deficits may not be apparent in basic communication interactions, but become more obvious during complex conversations following non-aphasic brain injury (NABI) or right hemisphere stroke (RHD). The purpose of this three-part dissertation was to examine discourse production deficits following NABI and the current practices of speech- language pathologists in the assessment and treatment of discourse deficits. The first study examined the macrolinguistic processes of discourse, which included local coherence, global coherence and cohesion, following NABI. Ten individuals with NABI and 10 heathy controls, closely matched for age, gender, and education, provided a narrative recount of an event. Discourse samples were analyzed for local coherence, global coherence, and cohesion. Results indicated that individuals with NABI demonstrated impaired global coherence compared to healthy controls with relatively intact local coherence and cohesion. Although global coherence deficits were identified in the discourse of individuals with NABI, empirical evidence suggests that speech-language pathologists do not routinely assess or treat discourse production deficits. The second study explored the current practices of speech-language pathologists in the assessment and treatment of individuals with NABI with a specific focus on discourse production deficits using a phenomenological approach. Nine speech-language pathologists participated in semi-structured 1:1 interviews. Results indicated that speech- language pathologists do not routinely assess and treat discourse production deficits due to competing internal values and external or environmental demands. However, speech- 2 language pathologists reported that discourse deficits are present following NABI and are characterized by impaired topic maintenance or global coherence. Participants reported that they were routinely assessing and treating the underlying cognitive process of attention in hopes that it would generalize to improved topic maintenance or global coherence. However, little is known about the relationship between selective attention and global coherence. The third study examined the maintenance of global coherence across discourse tasks and explored the relationship between selective attention and global coherence. Eleven participants with non-aphasic brain injury secondary to right hemisphere stroke participated in the study. Participants provided discourse samples in response to five discourse tasks in a single-task and dual-task condition. Additionally, participants completed the Stroop test to examine selective attention abilities. Results indicated that mean global coherence scores differed across discourse tasks, and that mean global coherence scores for stories was significantly higher than for simple recount and single picture description tasks. To examine the relationship between selective attention and global coherence, mean global coherence scores in the single-task and dual-task condition were compared. Mean global coherence scores were lower in the dual-task condition for all five discourse tasks. Mean global coherence scores for the complex recount task were significantly lower in the dual-task condition. This suggests that the maintenance of global coherence is influenced by attention abilities. There was no significant correlation between performance on the Stroop task and the maintenance of global coherence for any of the five discourse tasks. Key Words: global coherence, discourse, right hemisphere disorder, attention Katherine McComas Maddy September 19, 2017 3 THE RELATIONSHIP BETWEEN SELECTIVE ATTENTION AND GLOBAL COHERENCE IN NARRATIVE DISCOURSE FOLLOWING RIGHT HEMISPHERE STROKE By Katherine McComas Maddy Dr. Gilson J. Capilouto Co-Director of Dissertation Dr. Anne Harrison Co-Director of Dissertation Dr. Esther Dupont-Versteegden Director of Graduate Studies September 19, 2017 4 Acknowledgments This dissertation is the product of many individuals whom must be acknowledged for their endless support throughout this process. Gilson, thank you for taking a chance on me when I was a struggling student. I was struggling to narrow my questions and find my passion, and you took me in and with your discipline and focus, guided me to explore the questions I wasn’t able to ask yet. You always encouraged me to stay true to my clinical questions and pursue the difficult but fulfilling path. You not only supported me academically, but encouraged my growth while balancing being a wife, mother, clinician, researcher, and friend. For that, I’m most grateful. To Anne, Dana, Lee and Phillip, I am thankful for each question you asked and the new perspective you added to this research. This dissertation has truly been an interdisciplinary effort. There were many meetings where we narrowed questions, defined terminology, reflected on the literature, and then of course, revised a model before revising a model again. Thank you for your guidance throughout my doctoral studies. To the speech-language pathologists at Cardinal Hill Rehabilitation Hospital and the University of Kentucky Enterprise, thank you for believing in me and supporting me along the way. As a young clinician, I was supported by a strong team of clinicians at Cardinal Hill that challenged me to pursue this doctoral program to advance my career and develop as a clinical researcher. April and Liz, I appreciate your efforts recruiting participants and your assistance in ensuring that my data collection ran smoothly. Thank you, colleagues, at the University of Kentucky Enterprise for supporting my research endeavors by allowing flexibility and understanding when